<%@ page language="java" contentType="text/html; charset=utf-8"
    pageEncoding="utf-8"%>
    <%@ taglib uri="http://java.sun.com/jsp/jstl/core" prefix="c" %>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
<meta http-equiv="Content-Type" content="text/html; charset=utf-8">
<title></title>
<link rel="stylesheet" href="${pageContext.request.contextPath}/static/css/pintuer.css">
<link rel="stylesheet" href="${pageContext.request.contextPath}/static/css/admin.css">
<script src="${pageContext.request.contextPath}/static/js/jquery.js"></script>
<script src="${pageContext.request.contextPath}/static/js/pintuer.js"></script>

<link rel="stylesheet" href="${pageContext.request.contextPath}/static/jquery-ui-1.12.1.custom/jquery-ui.css">
<!-- <link rel="stylesheet" href="/resources/demos/style.css"> -->
<script src="https://code.jquery.com/jquery-1.12.4.js"></script>
<script src="${pageContext.request.contextPath}/static/jquery-ui-1.12.1.custom/jquery-ui.js"></script>




</head>
<body>

<div class="panel admin-panel ">
  <div class="panel-head" id="add"><strong><span class="icon-pencil-square-o"></span>确认报销内容</strong></div>
  <div class="body-content">
    <form method="post" class="form-x" action="${pageContext.request.contextPath}/sys/expense.do?method=expenseMoney">
      <div class="form-group">
        <div class="label">
          <label>慢性病名称</label>
        </div>
        <div class="field">
        <input type="text" class="input w50" name="illName" value="${illName}" readonly/>
          <div class="tips"></div>
        </div>
      </div>
      
      <div class="form-group">
        <div class="label">
          <label>姓名</label>
        </div>
        <div class="field">
          <input type="text" class="input w50" name="name" value="${name}" readonly/>
          <div class="tips"></div>
        </div>
      </div>
      
      <div class="form-group">
        <div class="label">
          <label>身份证号</label>
        </div>
        <div class="field">
          <input type="text" class="input w50" name="idcardNumber" value="${idcardNumber}" readonly/>
          <div class="tips"></div>
        </div>
      </div>
     
      <div class="form-group">
        <div class="label">
          <label>农合证号</label>
        </div>
        <div class="field">
          <input type="text" class="input w50" name="farmingcardCode" value="${farmingcardCode}" readonly/>
          <div class="tips"></div>
        </div>
      </div>
      
      <div class="form-group">
        <div class="label">
          <label>医疗费用</label>
        </div>
        <div class="field">
          <input type="text" class="input w50" name="medicalPays" value="${medicalPays }"  readonly/>
          <div class="tips"></div>
        </div>
      </div>
      
      <div class="form-group">
        <div class="label">
          <label></label>
        </div>
        <div class="field">
          <button class="button bg-main icon-check-square-o" type="submit"> 提交</button>
          <a class="button border-red" href="${pageContext.request.contextPath}/sys/expense.do?method=checkPersonInfoByIdCardNumber&idCardNum=${idcardNumber}">取消</a>
        </div>
        
      </div>
    </form>
  </div>
</div>

</body>
</html>